Tobacco is responsible for more than one in six deaths in the United States. It is well-documented that cigarette smoking is a major risk factor for both coronary artery disease and chronic obstructive pulmonary disease. Over 30% of all cancer deaths are due to tobacco. Rural Appalachians are at risk for tobacco-related diseases since their tobacco prevalence rates are higher, as compared to national statistics. However, little is known about tobacco characteristics of this population. Characteristics of rural Appalachians include a close-knot environment and use of lay practitioners for health services. An approach to tobacco cessation that combines existing local agencies, such as a County Nurse and County Extension Agent, with a lay facilitation model, may represent an effective mechanism for reaching rural Appalachian tobacco users. The specific aims of this proposal include: the assessment of tobacco consumption variables, the implementation of a nurse-managed model, lay led stage-specific tobacco cessation intervention and the evaluation of the intervention's effectiveness among rural Appalachian adult tobacco users. Two rural Appalachian counties in Ohio will participate in the study. One county will be randomly assigned to intervention, while the other will serve as the control county. Eligible adult tobacco users in both counties will be assessed for tobacco use characteristics. Intervention county residents will receive a locally-based cessation intervention that will be managed by the county nurse in the intervention county and delivered by trained lay educators. The county extension agent will be responsible for recruitment and retention efforts in this project. At the end of treatment, and 6 and 12 months post-treatment, participants from the counties will be reassessed for tobacco use, using self-report and saliva cotinine analysis. Comparison of quit rates will be performed by the chi square statistic. Multivariate logistic regression analysis will be performed to describe a model of quitter versus continuing smoker.